Solitary keratoacanthoma involving upper lip: a diagnostic dilemma - case report and a brief review

Keratoacanthoma (KA) is a benign epithelial proliferative lesion which frequently occurs on the sun exposed areas of the skin. KA originates within the pilosebaceous apparatus of the skin and may be solitary or multiple. Solitary KA can be difficult to differentiate from squamous cell carcinoma (SCC) both clinically and microscopically. However, the clinical course of the lesion and its ability to self involute makes it a distinct clinical entity. Solitary KA appears on the vermilion border of the lower lips with some frequency. A case of keratoacanthoma involving the upper lip is reported presenting as an exophytic growth that resolved after excisional biopsy. Photo- graphic documentation of the case along with relevant management protocol is discussed. The article emphasizes the significance of recognizing such lesion and discriminating it from SCC thus carrying diagnostic and therapeutic implications. However, in case of dilemma it is prudent to assume that the lesion is SCC unless proved otherwise clinically or histologically

Botulinum toxin: a boon or bane in dentistry

Botulinum toxin is a neurotoxin which is produced by the Clostridium botulinum bacteria. It is an anaerobic, gram-positive, spore-forming rod-shaped bacteria which is commonly found in soil, on plants, in water and in the intestinal tracts of animals. All the serotypes of botulinum toxin interfere with neural transmission by blocking the release of acetylcholine. The use of botulinum toxins has revolutionised the treatment of various ophthalmic spastic disorders, Orofacial pain conditions, facial dystonia and periocular wrinkles. A precise knowledge and understanding of the functional anatomy of the mimetic muscles is absolutely necessary to correctly use botulinum toxins in clinical practice. This article is an effort to understand Botulinum toxin and its applications in head and neck

Review: recent trends in management of oral lichen planus

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory disease, associated with altered cell‐mediated immunological function. It has been characterised by long‐term evolution, repeated exacerbations, sometimes painful and resistant to treatment, or even all of these. OLP significantly affects quality of patient's life. There is a higher risk of malignant transformation accompanied with OLP and similar appearing oral lichenoid lesions. Current OLP therapy aims at eliminating all mucosal‐related lesions reduce symptomatology and decrease the risk of oral cancer. This review summarizes recent treatment modalities used in the management of OLP which includes corticosteroids, immunomodulatory agents, retinoids, ultraviolet irradiation and/or laser therapy, herbal remedies. In addition, focus is also given upon adopting holistic approach in such patients by emphasizing on stress management

Comparative evaluation of autologous platelet rich plasma and triamcinolone acetonide injection in the management of erosive lichen planus and oral submucous fibrosis: a clinical study

Background: It is need of an hour to establish an effective and efficient treatment modality for OLP and OSMF with lesser or no adverse effects. Platelet rich plasma can be used in mucosal lesions as it has a high concentration of various growth factors and anti-inflammatory properties. It could be a better novel substitute to the corticosteroid without any side effects. The present study is an effort to evaluate the therapeutic effects of intralesional injection of PRP in oral erosive lichen planus and OSMF compared to intralesional corticosteroids in the same patient. Methods: It was a randomized controlled clinical study consisting of 40 patients between the age groups of 18-60 years visiting dental OPD diagnosed clinically with either erosive lichen planus or OSMF. Triamcinolone 40 mg(1mg/ml) mixed with 2% (1:80,000) lignocaine hydrochloride was injected into the lesion on one side in case of erosive lichen planus and into the submucosal plane and fibrous bands in case of OSMF patients. Autologous PRP was prepared and injected on the other side in same patients. At every visit, all the patients were evaluated for pain and burning sensations, size, and severity of the lesion, and interincisal mouth opening (mm). The parameters were measured and recorded during the patient’s every visit. All the results were obtained and statically analyzed. Results: Intralesional injections of triamcinolone acetonide and PRP are effective in reducing pain and burning sensation in OSMF, but PRP is less effective in improving cheek flexibility as compared to triamcinolone acetonide. In OLP, both triamcinolone acetonide and PRP are almost equally effective in reducing the size of the lesion. However, PRP shows slightly better results in reducing the severity of the lesion and in pain and burning sensation in the patients of OLP as compared to intralesional triamcinolone acetonide. Conclusions: Thus, PRP is an effective modality in treating both OSMF and oral erosive lichen planus with no adverse effects

Diagnostic efficiency of toluidine blue with Lugol′s iodine in oral premalignant and malignant lesions

Background and Objectives: In vivo stains are prompt resources, which have emerged, in the recent years, to aid as clinical diagnostic tools in detecting early premalignant and malignant lesions. The aim of the study was to determine the diagnostic efficiency of toluidine blue with Lugol′s iodine in oral premalignancies and malignancies and to evaluate the reliability of in vivo staining with toluidine blue and Lugol′s iodine in the lesions at risk of malignancy. Materials and Methods: The study group comprised 30 subjects with clinically suspicious premalignant lesions and 30 subjects with clinically suspicious malignant lesions. All the lesions were stained consecutively with toluidine blue and Lugol′s iodine and the dye retention were recorded with photographs. Depending on the retention of the dyes, the biopsy site was determined. The biopsy specimens were sent for histological confirmation and results were statistically analyzed. Results: The overall diagnostic accuracy of Lugol′s iodine when used consecutively with toluidine blue stain in distinguishing premalignant lesions and malignant lesions was 90%. As the degree of differentiation of malignant lesions progressed toward more severity, they failed to show the retention of Lugol′s iodine and the result was highly significant statistically, with a P value < 0.001. Interpretation and Conclusion: Lugol′s iodine when used with toluidine blue helped in delineating the inflammatory lesions and was the mean source in determining clinically the degrees of differentiation of malignant lesions as the poorly differentiated malignant lesions without glycogen content failed to show Lugol′s iodine retention. Toluidine blue with Lugol′s iodine can be used as a pretherapeutic assessment of the biologic aggressiveness of the disease

“Radiographic demonstration of association of ubernaculum Dentis (Gubernaculum tract) in odontogenic cysts and tumors”-A CBCT finding

Spectrum of lesions that occur in the jaws have a cyst-like radiographic appearance. These lesions may be odontogenic or non-odontogenic and are often difficult to differentiate them on the basis of their clinical, radiographic features alone. Among odontogenic lesions without mineralization, ameloblastomas, odontogenic keratocysts, and dentigerous cysts can all appear as well-defined, unilocular, well-corticated, lucent lesions that can mimic with non-odontogenic cysts and tumors like nasopalatine duct cyst, aneurysmal bone cyst, central giant cell granuloma, hemangioma and so on. So understanding the pathogenesis of these lesions become the most imperative criteria for determining the additional investigations and treatment protocol. We hereby discuss 8 diagnosed cases of odontogenic and non-odontogenic jaw lesions, which were retrospectively visualized in cone beam computed tomography(CBCT), and an association of gubernaculum tract(cord) with odontogenic origin lesions was demonstrated

Intraosseous verrucous carcinoma arising from an orthokeratinized odontogenic keratocyst: A report of a rarest entity

Intraosseous verrucous carcinomas (VCs) arising from odontogenic cysts are a rare entity. An unusual case of a VC arising from the orthokeratinized odontogenic cyst is described for the first time. The microscopic features of the lesion are presented

Role of dental findings in the diagnosis of idiopathic hypoparathyroidism

Idiopathic hypoparathyroidism (IHP) is a rare endocrinopathy, characterized by the disturbances in the calcium and phosphorous metabolism, owing to deficiency in parathyroid hormone, which leads to tetanic manifestations. Onset of the clinical features occurs early in the life and the seventy depends on the extent of chemical imbalance. This article describes a case of 22-year-old male patient undiagnosed for 12 years with this endocrinopathy (IHP). Overretained deciduous teeth, delayed eruption, impacted tooth and short roots probably resulting from untreated hypocalcemia during the developmental phase of dentition enabled us to unearth this endocrinopathy through a series of investigations. Thus, the article emphasizes the importance of dental findings of this endocrinopathy

Comparison of conventional pharmacological therapy and holistic approaches (Naturopathy and Yoga) in the management of chronic orofacial pain: A randomized controlled study

Background: Orofacial pain disorders and their management forms an important and integral part of our oral medicine specialty. Only oral physicians are well-trained to provide non-surgical treatment of these complex disorders. Today, the escalating costs of drugs and several adverse effects associated with modern medicines have led to the search of alternative systems all over the world. Hence, this study is an effort to assess the efficacy of holistic approaches (naturopathy and yoga) alone as well as in combination with pharmacological therapy in the treatment of chronic orofacial pain of non-odontogenic origin. Materials and Methods: The present study was conducted on 60 patients who were randomized into three groups A, B and C, each group consisting of 20 patients (10 of myofascial pain and 10 of trigeminal neuralgia). In group A it was prescribed conventional medicines for their respective treatment. Holistic approaches (naturopathy and yoga) were added with conventional pharmacological therapy in group B and only holistic approaches were performed in group C. The duration of treatment was of 3 months a and the patients were analysed using pain scale, quality of life scale (QOL) and stress scale after every ten days follow-up. Results: The patients of trigeminal neuralgia showed best result when treated with pharmacological treatment. The holistic approaches showed significant results only when combined with pharmacological therapy for the treatment of trigeminal neuralgia. On the other hand, holistic approaches works best in myofascial pain both alone and in combination with pharmacological therapy. Acupuncture and facial massage along with yoga have a great impact on quality of life by reducing stress and anxiety of the patient. Conclusion: Holistic approaches are useful means in treating patients with chronic orofacial pain as it eliminates the risk of adverse effects associated with long term use of muscle relaxants and anti-convulsants

Sunburst appearance in odontogenic myxoma of mandible: A radiological diagnostic challenge

Odontogenic myxoma in the jaws is infrequent, accounting for only 3%-6% of odontogenic tumours. The radiological appearance of this tumor is complicated and there exist controversies regarding its internal structure and locularity. The "sunray" or "sunburst" appearance in Odontogenic myxoma has been reported in the literature although rarely. Here we report a case of odontogenic myxoma in the mandible showing sunburst appearance which posed a diagnostic dilemma for the oral radiologists. We also emphasize the usefulness of Cone Beam Computed Tomography in the diagnosis of such lesions